Hayes K, Deshmukh A, Pant S, Tobler G, Paydak H. Concept of defibrillation vector in the management of high defibrillation threshold. World J Cardiol 2013; 5(4): 106-108 [PMID: 23675557 DOI: 10.4330/wjc.v5.i4.106]
Corresponding Author of This Article
Sadip Pant, MD, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR 72205, United States. spant@uams.edu
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Apr 26, 2013; 5(4): 106-108 Published online Apr 26, 2013. doi: 10.4330/wjc.v5.i4.106
Concept of defibrillation vector in the management of high defibrillation threshold
Kevin Hayes, Abhishek Deshmukh, Sadip Pant, Gareth Tobler, Hakan Paydak
Kevin Hayes, Abhishek Deshmukh, Hakan Paydak, Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Sadip Pant, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Gareth Tobler, Department of Cardiothoracic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Author contributions: Hayes K and Deshmukh A conceived the study, participated in its design and coordination and helped to draft the manuscript; Pant S participated in drafting of manuscript, literature review; Tobler G and Paydak H co-investigator, case analysis, and manuscript editor.
Correspondence to: Sadip Pant, MD, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR 72205, United States. spant@uams.edu
Telephone: +1-501-4059729 Fax: +1-501-4059438
Received: September 19, 2012 Revised: March 15, 2013 Accepted: March 21, 2013 Published online: April 26, 2013 Processing time: 220 Days and 11.5 Hours
Abstract
We present a case where defibrillation threshold was dangerously elevated to the point that the patient had no safety margin, and his implantable cardioverter-defibrillator generator was discovered to have migrated. Generator migration reduces the distance between the can and the coil, effectively creating a smaller bipolar current and sparing the left ventricle from the current needed for defibrillation. This case underscores the importance of securing the generator in place, as this patient would have been spared multiple shocks and an invasive medical procedure had his generator been better secured.
Core tip: Defibrillation threshold can be altered by a myriad of factors including generator migration. We report a case to illustrate the concept of implantable cardioverter-defibrillator defibrillation vectors and its effect on defibrillation threshold.
